The invention relates to a soft-tissue implant having antibacterial properties for use in the medical field.
Soft-tissue implants are used to fill tissue. The perhaps most known soft tissue implant is the breast implant used to increase breast size.
Breast implants normally include a polymer sheath, preferably silicone, whereby the implant is filled with silicone (highly cohesive) or an isotonic salt solution (NaCl) in order to provide the implant with properties similar, if not identical to, the living tissue that the implant augments or replaces.
Breast implants may cause different complications, e.g. infections, after the implantation. According to its intended purpose, a medical implant is placed at the location of implantation through a small, surgically created opening in the body. In this process, the implant comes inevitably in contact with the skin that surrounds the opening. As a result of bacterial contamination of the implant, an infection may occur after the operation (Vinh D. C. et. al., Breast Implant Infection with Myobacterium Fortuitum Group: Report of Case and Review, Journal of Infection 2006, Volume: 52. e63-e67). According to literature, infections occur in 9% of the operations (Aesthetic Surg J 2005; Volume 25, pages 249-254; Antonio Roberto Basile, M D; Filipe Basile, M D; and Arthur Volpe Dangieri Basile: Late Infection Following Breast Augmentation With Textured Silicone Gel-Filled Implants). About 2% of the infections are observed during the first 20 days after the operation and about 3% are observed during 20-288 days (on average after 82 days). Bacteria are able to build up a biofilm on implant surfaces and survive in it during an extended period of time.
Biofilms protect bacteria against antibiotics, as well. If a biofilm exists on an implant surface the bacteria can be controlled by agents beyond the biofilm but it may be that the infection spreads in the implant-containing body over a period of weeks, months, or even years.
Another problem is the increasing resistance of microorganisms against antibiotics. For this reason it makes sense to provide the implant surface with an antibacterial coating.
Apart from the existence of resistant germs, capsular contracture is another possible complication that, in the worst case, can lead to the explantation of the breast implants because the contraction of the connective tissue capsule can cause tactile sclerotizations, breast deformation and even the rupture of the silicone sheath.
About 20% of the women who have an implant suffer from capsular contracture (Benediktsson K. an Perbeck L., N Irradiated and Non-Irradiated Breast Cancer Patients: Five Years of Monitoring of a Prospective Trial, Journal of Plastic, Reconstructive & Aesthetic Surgery 2006; Volume 59, pages 27-34).
The cause of capsular contracture is not yet known. Among other reasons, a bacterial colonization of the implant has been considered (Virden C. P. et al.; Subclinical Infection of the Silicone Breast Implant Surface as a Possible Cause of Capsule Contracture, Aesth. Plast. Surg., 16 (1992) 173; Handel N. et al.; The Date of Breast Implants: A Critical Analysis of Complications and Out-Comes; Plast. Reconstr. Surg., 86 (1995) 1521; Dopke M. K. et al., Characterisation of Microbial Presence at the Surface of Silicone Mammary Implants, Ann. Plast. Surg., 34 (1995) 563; Prantl L. et al.; Clinical and Morphological Conditions in Capsular Contracture Formed Around Silicone Breast Implants, Plast. Reconstr. Surg., 120 (2007) 275-284).
The most frequent type of breast implant procedure takes place to increase the size of the breast. Less frequently, the implant is inserted to augment the breast after tumor removal. Normally, the implant consists of a sheath of silicone, seldom of polyurethane, filled with silicone, isotonic salt solution, soybean oil (that was already taken from the market) or other liquids such as collagen solution (see DE 195 30 249 A1) to give the implant consistency that is similar to the breast tissue.
The production of breast implants by machines is known, for example, from EP 1 432 562 B1). The manufacture of specific geometries is disclosed in EP 1 267 725 B1.
DE 695 34 083 T2 introduces a breast implant with autologous cells in a polymer matrix based on a hydrogel. The use of metal ions with an antibiotic effect has been known for quite a long time.
Metal ion complexes formed between at least one metal ion and an organic complexing agent have also been known for a long time. Calcium ions, for example, complex with ethylenediaminetetraacetate (EDTA) in coagulation examinations. Apart from molecules such as EDTA, certain polymers or polysaccharides are known to have functional groups used to form complexes. Carboxyl groups and amino groups have a complexing effect for polysaccharides; usually polysaccharides that contain amino groups are used.
The use of metal ion/polysaccharide complexes has not only been described in technical applications but also in medicine. For example, a chitosan-copper complex is used in tumor treatment because of its increased activity compared to uncomplexed copper ions (Yong Zheng et al.; Preparation of Chitosan-Copper Complexes and their Antitumor Activity; Bioorganic & Medicinal Chemistry Letters 16 (2006) 4127-4129).
It is also known that implantable systems of chitin and chitosan can selectively release active substances if the pH-value is changed. This change can be realized, for example, by a kind of controllable membrane made of these materials (Eugene Khor and Lee Yong Lim; Implantable Applications of Chitin and Chitosan; Biomaterials 24 (2003) 2339-2349).
Moreover, diverse coatings of implants having an antibacterial effect are known.
Well-known procedures such as the change of the hydrophobicity/hydrophilicity, the use of smooth or structured surfaces have already been examined.
In WO 2004/096308, for example, a metal coating on the outer side of the silicone sheath of breast implants is described.
Coatings of polysaccharides, such as chitosan and chitosan derivatives for the surface coating of implants and medical instruments, are disclosed in DE 197 24 869 A1. Other polysaccharide coatings are disclosed, for example, in DE 44 44 445 C2.
WO 03/060003 A1 describes the production process of plastics articles (thermoplastics) for consumer goods by extrusion (injection molding) in which a metal-chitosan complex with antibacterial effect is added to the polymer mass.
An antibacterial film has been generated by a polysaccharide coating that contains silver nano-particles (Jinhong Fu et al.; Construction of Antibacterial Multilayer Films Containing; Journal of Biomedical Materials Research Part A, Volume 79A, 3 (2006) 665-674).
An antibacterial effect can also be produced for silicone implants by increasing the hydrophobicity. This effect is achieved by a surface silanization or polysaccharide coating without metal ions or active substances (H. Tang et al.; Effect of Surface Modification of Silicone on Staphylococcus Epidermidis Adhesion and Colonization; Colloids and Surfaces B: Biointerfaces 51 (2006) 16-24).
A completely absorbable implant is produced by the cross-linking of chitosan with glutaraldehyde. By the addition of radioactive iodine a local radiation can be realized for brachytherapies. (Abdel Kareem Azab et al.; Crosslinked Chitosan Implants as Potential Degradable Devices for Brachytherapy: In Vitro and in Vivo Analysis; Journal of Controlled Release 11 (2006) 281-289).
Another kind of coating is described in DE 102 43 132 B4. Here, copper ions are released from a copper-containing titanium dioxide layer that is applied on implants. This layer is produced by metal-organic titanic oxide precursors and its formation requires a thermal conversion.
Agent-releasing systems that release antibiotic substances are also known for implants. DE 1023 32 072 B4, for example, describes an individually adjustable agent-releasing system. Here, an implantable carrier is provided with several openings in which the agents of different types are introduced. In this system, the active agents are released locally in a small region. For example, this implant, filled with antibiotics, can be screwed into the inflamed opening after the removal of an external fixation. This technique does not allow a large-surface and uniform release of agents, e.g. the generation of an antibacterial surface on a breast implant.
DE 10 2005 002 703 A1 discloses an antibiotic coating of implants that consists at least of one saturated, organic, hydrophobic, low-molecular matrix former that has a melting point in the temperature range from 45° C. to 100° C. and a low-molecular, hydrophobic additive is dissolved in it. An antibiotic/antibiotic is suspended in the mixture of the matrix former and additive and/or an antibiotic/antibiotics that can be mixed with the mixture of the matrix former and additive is dissolved in it.
DE 102 54 215 A1 describes a surgical, antimicrobial implant with a basic structure and at least a partial coating. The implant has alpha-hydroxycarboxylic acid oligomers (preferentially lactic acid oligomers) and/or allows them to develop as a degradation product after the implantation. The coating contains polyol fatty acid monoester, preferably glycerol fatty acid monoester.
In DE 101 14 364 A1, a method for the production of antibiotic compositions is explained. In this method a plastically deformable salt, which is built up of at least one cationic component of a protonized antibiotic base from the groups of the amino glycoside antibiotics, the lincosamide antibiotics and the tetracycline antibiotics and of at least one anionic component of the group of the organic sulfates and/or organic sulfonates and/or fatty acid esters, is used for the fixation of the inorganic composite components and/or organic composite components and, possibly by the addition of water, for the formation of the composites, particularly by pressing, extruding, rolling, calendaring and milling processes.
DE 101 14 245 A1 describes the production and use of an antibiotic/antibiotics preparation for human and veterinary medicine for the treatment of local microbial infections in hard and soft tissues. According to this invention, an antibiotic/antibiotics preparation is produced by mixing water, an amphiphilic component of a representative of the alkylsulfates, arylsulfates, alkylaryl sulfates, cycloalkyl sulfates, alkylcycloalkyl sulfates, alkyl sulfamates, cycloalkyl sulfamates, alkylcycloalkyl sulfamates, aryl sulfamates, alkylaryl sulfamates, alkyl sulfonates, fatty acid-2-sulfonates, aryl sulfonates, alkylaryl sulfonates, cycloalkyl sulfonates, alkylcycloalkyl sulfonates, alkyl bisulfates, cycloalkyl bisulfates, alkyl bisulfonates, cycloalkyl bisulfonates, aryl bisulfonates, alkylaryl bisulfonates, aryl trisulfonates and alkylaryl trisulfonates, one or more antibiotic components from the group of the aminoglycoside antibiotics, the lincosamide antibiotics and tetracycline antibiotics, an organic auxiliary component and/or an inorganic auxiliary component and, possibly, at least one biologically active auxiliary component and this mixture is formed to molded bodies, granulated materials, powders, films, fleeces and threads.
DE 101 14 244 A1 discloses an antibiotic/antibiotics preparation for absorbable and non-absorbable implants for human and veterinary medicine for the treatment of local microbial infections in hard and soft tissues. This antibiotic/antibiotics preparation is a mixture consisting of at least one amphiphilic component of a representative of the alkyl sulfates, aryl sulfates, alkylaryl sulfates, cycloalkyl sulfates, alkylcycloalkyl sulfates, alkyl sulfamates, cycloalkyl sulfamates, alkylcycloalkyl sulfamates, aryl sulfamates, alkylaryl sulfamates, alkyl sulfonates, fatty acid-2-sulfonates, aryl sulfonates, alkylaryl sulfonates, cycloalkyl sulfonates, alkylcycloalkyl sulfonates, alkyl bisulfates, cycloalkyl bisulfates, alkyl bisulfonates, cycloalkyl bisulfonates, aryl bisulfonates, alkylaryl bisulfonates, aryl trisulfonates and alkylaryl trisulfonates and of at least one antibiotic components from the group of the aminoglycoside antibiotics, the lincosamide antibiotics or tetracycline antibiotics and, possibly, at least of one waterless organic auxiliary component and, possibly, of at least one inorganic auxiliary component and, possibly, of at least one biologically active auxiliary component. This inventive antibiotic/antibiotics preparation exhibits a delayed release of the active agents.
DE 699 35 677 T2 describes an antibiotic hydrophilic coating.
US 2003/0203003 A1 discloses a degradable implant consisting of fibers that are filled with agents. By weaving two different fibers different agents can be released or within one fiber different agents can be released in different regions. In this technical solution the agent can be released across a surface.
US 2007/0160641 A1 discloses a stent used for a medical device. Here, a layer structure with two regions of different release kinetics or several layers can be provided.
DE 102 43 132 B4 discloses a method for the production of a biocompatible metal-ion-containing titanium oxide coating on an implant. The metal ions can be eluted under physiological conditions, are homogeneously distributed in the coating and can have an antibiotic effect. According to this method, the TiO2 coating is applied at a temperature ranging from 100 to 1000° C. and an inner layer can consist of Cu or Ag so that, depending on the ions, different release kinetics can exist.